Provider Demographics
NPI:1932228475
Name:DELTA MEDICAL SERVICES P.C
Entity Type:Organization
Organization Name:DELTA MEDICAL SERVICES P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FUNSHO
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSARI-ALABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-633-8400
Mailing Address - Street 1:475 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-5537
Mailing Address - Country:US
Mailing Address - Phone:914-633-8400
Mailing Address - Fax:
Practice Address - Street 1:475 WHITE PLAINS RD
Practice Address - Street 2:SUITE 18
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-5537
Practice Address - Country:US
Practice Address - Phone:914-633-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237437261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02900498Medicaid
NYWZZPW1Medicare PIN